Adrenal venous sampling for lateralization of cortisol hypersecretion in patients with bilateral adrenal masses

Autor: Paige C. Johnson, Scott M. Thompson, Daniel Adamo, Chad J. Fleming, Irina Bancos, Travis J. McKenzie, John Cheville, William F. Young, James C. Andrews
Rok vydání: 2022
Předmět:
Zdroj: Clinical Endocrinology. 98:177-189
ISSN: 1365-2265
0300-0664
Popis: The objective of this study was to evaluate the role of adrenal venous sampling (AVS) in guiding the management of patients with corticotropin (ACTH)-independent glucocorticoid secretory autonomy and bilateral adrenal masses.A cohort with 25 patients underwent AVS and surgical management.Cortisol was measured from the adrenal veins (AVs) and inferior vena cava (IVC). AV/IVC cortisol ratio and cortisol lateralization ratio (CLR) (dominant AV cortisol concentration divided by the nondominant AV cortisol concentration) were calculated. Posthoc receiver-operating characteristic curves were generated to determine the specificity of revised AV/IVC cortisol ratio and CLR in differentiating unilateral from bilateral disease.Patients underwent unilateral (n = 21) or bilateral (n = 4) adrenalectomy. The mean AV/IVC cortisol ratio for unilateral adrenalectomy was 12.1 ± 9.6 (dominant) and 4.7 ± 3.8 (contralateral) with a mean CLR of 3.6 ± 3.5. The mean AV/IVC cortisol ratio for bilateral adrenalectomy was 7.5 ± 2.1, with a mean CLR of 1.1 ± 0.6. At a mean follow-up of 22 months, one patient who underwent unilateral adrenalectomy for the predicted bilateral disease developed recurrent mild autonomous cortisol secretion. Posthoc analyses demonstrated a specificity of 95%-100% for unilateral disease with AV/IVC cortisol ratio9 for one side,2.0 for the opposite side and a CLR 2.3. The specificity was 80%-90% for bilateral disease with AV/IVC cortisol ratio5.1 bilaterally and a CLR 1.1.Among patients with bilateral adrenal masses and ACTH-independent autonomous cortisol secretion, AVS can distinguish between unilateral and bilateral disease with high specificity and may guide surgical management.
Databáze: OpenAIRE
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